North Bristol NHS Trust

About: North Bristol NHS Trust is a healthcare organization based out in Bristol, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 2204 authors who have published 2811 publications receiving 61110 citations.

Clinical outcomes of hospitalised patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study.

Abstract: Although catheter-associated urinary tract infection (CA-UTI) is a major healthcare-related problem worldwide, there is a scarcity of current data from countries with high antimicrobial resistance rates. We aimed to determine the clinical outcomes of patients with CA-UTI compared to those of patients with other sources of complicated urinary tract infection (cUTI), and to assess the impact of antimicrobial resistance. We also aimed to identify the factors influencing 30-day mortality among patients with CA-UTI. This was a multicentre, multinational retrospective cohort study including hospitalised adults with cUTI between January 2013 and December 2014 in twenty hospitals from eight countries from southern Europe, Turkey and Israel. The primary endpoint was 30-day mortality. The secondary endpoints were length of hospital stay, symptom improvement after 7 days’ treatment, symptom recurrence at 30 days and readmission 60 days after hospital discharge. Of the 807 cUTI episodes, 341 (42.2%) were CA-UTIs. The time from catheter insertion to cUTI diagnosis was less than 2 weeks in 44.6% of cases. Overall, 74.5% of cases had hospital or healthcare-acquired CA-UTI. Compared to patients with other cUTI aetiologies, those with CA-UTI had the following characteristics: they were more frequently males, older, admitted for a reason other than cUTI and admitted from a long-term care facility; had higher Charlson’s comorbidity index; and more frequently had polymicrobial infections and multidrug-resistant Gram-negative bacteria (MDR-GNB). Patients with CA-UTI also had significantly higher 30-day mortality rates (15.2% vs 6%) and longer hospital stay (median 14 [interquartile range -IQR- 7-27] days vs 8 [IQR 5–14] days) than patients with cUTI of other sources. After adjusting for confounders, CA-UTI was not independently associated with an increased risk of mortality (odds ratio, 1.40; 95% confidence interval, 0.77–2.54), and neither was the presence of MDR-GNB. CA-UTI was the most frequent source of cUTI, affecting mainly frail patients. The mortality of patients with CA-UTI was high, though this was not directly related to the infection.

Anisotropy of spin-echo T2 relaxation by magnetic resonance imaging in the human brain in vivo

Abstract: BACKGROUND: The use of T2 relaxation contrast, as measured by MRI, is particularly commonplace in non-invasive assessment of the brain. However, the mechanisms and uses of T2 relaxation in the brain are still not fully understood. The hypothesis that T2 relaxation may show anisotropy in the human brain was studied at 3 T. T2 anisotropy refers to the variation of T2 in ordered structures with respect to the direction of the applied magnetic field. METHODS: Using a 3 T clinical MRI scanner, we made quantitative multi-contrast spin-echo T2 and diffusion tensor imaging (DTI) measurements in healthy volunteers, repeating the measurements with the subject’s head oriented differently relative to the applied field, for the measurement of possible spin-echo T2 anisotropy. RESULTS: We report T2 relaxation anisotropy measurements and present a means for visualising it according to the principal orientation of ordered structures in the brain parenchyma. We introduce a parameter for the model-free description of T2 anisotropy, namely the T2 “fractional anisotropy”, similar to that used to describe anisotropy of translational diffusion. This parameterisation enables the overall level of anisotropy in T2 across a chosen region or tissue to be calculated. Anisotropic T2 relaxation was observed in both gray and white matter, though to a greater extent in the latter, with a strong relationship with the anisotropy of translational diffusion. This is evidenced by making repeat measurements with the subject’s head tilted to different angles relative to the applied magnetic field, by which means we observed the T2 at the same anatomical site to change. CONCLUSIONS: Relaxation anisotropy has a significant effect on T2 in the brain parenchyma. It has the potential to offer non-invasive access to tissue microstructure not available by other imaging modalities, and may be sensitive to pathology or noxious factors not detected by other means.

Improving care for patients with idiopathic pulmonary fibrosis (IPF) in the UK: a round table discussion

Abstract: This article is the result of a round table discussion held at BMA House. Its purpose is to outline the challenges facing both patients and doctors in managing idiopathic pulmonary fibrosis. A number of recommendations for service development and research have been identified.